Self-assessment for neurosurgery residents by script concordance test (SCT). The process of test elaboration

Background - The script concordance test (SCT) is a new tool to assess clinical reasoning in a context of uncertainty. It was chosen for computer-based self-assessment training for neurosurgery residents. Purpose. - The aim of this work is to describe the construction of a first series of questions and provide teachers practical information needed to build a SCT. Method - The theorical background of the SCT is explained. We review the steps we followed when writing of a series of more than two hundred questions. Results. - We present the different steps of our work, including writing clinical cases, validation of questions and elaboration of scoring systems. We explain the main difficulties we encountered. Conclusion. - The script concordance test is an interesting easy-to-construct assessment tool useful for evaluating clinical competence. This work summarizes our experience in building a SCT, which should be helpful for teachers interested in this new assessment tool, especially in neurosurgery.